Infertility

Question 1

Infertility definition

Answer 1

The inability of a couple to acheive a clinical pregnancy within 12 months of beginning regular sexual intercourse

Question 2

Fecundibility defintion

Answer 2

the percentage of women exposed to the risk of a pregnancy for one menstrual cycle, who will subsequently fall pregnant

Question 3

cumulative pregnancy rates

Answer 3

term used to express the chance of conception within a given time interval

Question 4

Anovulation

Answer 4

the failure of the ovary to release ova over a given time generally exceeding 3 months. The normal functioning ovary releases one ovum every 25-28 days

Question 5

Types of infertility

Answer 5

• Primary - no previous pregnancies
• secondary - at least one pregnancy

Question 6

Incidence of infertility in the UK

Answer 6

1 in 6 couples

Question 7

Chance of pregnancy

Answer 7

• 30% in 1st 1 month
• 60% in first 6 months
• 84% in 1 year
• 92% in 2 years

Question 8

Factors affecting infertility

Answer 8

• Age- mainly female issue
• timing of intercourse - before ovulation as progesterone affects cervical mucus (2-3 times a week)
• duration of sub-fertility - >3 years chance of conception 1-3 % with each cycle
• previous pregnancy - if 2y inferility and normal investigations then 2 times more likely
• weight - less likely if BMI <20 or >30

Question 9

Causes of infertility

Answer 9

• Sperm (azoospermia or oligospermia)
• egg (anolvulation)
• meet and implant (timing causes, tubal causes)

Question 10

Male fertility can be a problem of?

Answer 10

• Sperm production
• sperm function
• sperm delivery

Question 11

Sperm production problems

Answer 11

• Complete absence of sperm production (azospermia) due to testicular failure
• Reduced sperm count with normal morphology (oligospermia)
• poor motiliy (asthenospermia)
• morpholically defective (tetarospermia) with abnormalities of the head, midpiece or tail

Question 12

Sperm function problems

Answer 12

Ability of the sperm to reach, bind and fertilise the oocyte

• no reliable methods of testing sperm function, other than monitoring sperm moving and assessing the speed of their progression

Question 13

Sperm delivery issues

Answer 13

• caused by absence or bloackge of the vas deferens or epididymis
• related to impotence, premature ejaculation or a physical inability to have normal sexual intercourse

Question 14

Semen analysis

Answer 14

sample provided after 2-5 days of abstaining and analysed in dedicated laboraty

assess:

• volume
• concentration
• total motility
• progressive motility
• normal forms
• vitality

NOTE gives little information of sperm function

Question 15

Male factors - Azoospermia

Answer 15

No sperm seen in sample

2 types:

obstructive

• normal spermatogenesis
• inability to leave in ejaculate
  
  • blockage in epididymis or vas deferens
  • congenital absence of vas deferens

non-obstructive

• testicular failure
  
  • biopsy - any island in spermatogeniss
  • check karyotype for XXY
  • check for Y microdeletions

OR

• failure to stimuate spermatogenesis (hypogonadotrophic hypogonadism)

Question 16

WHO classification of female infertility

Answer 16

Group 1- women with primary or secondary amenorrhea, low levels of endogenous gondotrophins and neglibile endogenous oestrogen acitivty

Group 2 - Patients with anovulation associated wth a variety of menstrual disorders who exhibit distinct endogenous oestrogen activity whos urinary and serum gonatoprins are in the normal range

Group 3 - Women with primary or scondary amenorrhoea due to primary ovarian failure associated with low enodgenous oestroen acitivty